Wow… a three-parter. Makes me think of “3-Peat”, which makes me think of the glory days of Da Bulls. I’d like to think of myself as the Michael Jordan of vein docs here in my arena at Rosen Vein Care, conveniently located in Northbrook. About the closest I’ll ever come to making a slam-dunk is a metaphorical one relating to endovenous ablation of varicose veins…and I think I can be satisfied with that.
True, I might not have a pair of Nike shoes designed especially for me (though the “swoosh” kinda looks like a tortuous vein).
True, I may not have a cologne bearing my name on the counter at Macy’s […what on earth would it smell like? Ablated vein? Ew.]
But…here in my office at Rosen Vein Care…I feel like a man in the prime of his career…standing at my equivalent of the 3 point line (next to the comfy table in my procedure room)…firing off one at the buzzer to score a victory against my arch nemesis: superficial venous insufficiency. Though you can’t see it under my surgical mask, my tongue is sticking out in true Jordan fashion. Maybe I should embroider a #23 on my scrub shirt?….
Ahem…let’s get back to our lecture, shall we? We left off with definitive treatment options for superficial venous insufficiency that were non-surgical, minimally-invasive and well-tolerated. Namely, we talked about endovenous laser ablation (EVLA)
In comparison to surgical options of yesteryear, EVLA rocks and it rocks hard. Ironically the discomfort associated with the procedure relates to the use of local anesthetic; once the anesthetic is placed, patients feel no discomfort…only boredom.
However, in the spirit of wanting to make the patient experience better and more comfortable, newer state-of-the-art procedures have arrived to deal with incompetent saphenous veins that DO NOT REQUIRE TUMESCENT LOCAL ANESTHESIA.
Today’s veinblog post will introduce you to Mechanical Occlusion with Chemical Assist (MOCA…or, as it is known by its trade name, Clarivein®).
This procedure has been around for about 5 years now and data is amassing about its efficacy. Similar to EVLA, Clarivein® is a minimally-invasive means to close incompetent veins from the inside (endovascular closure). Like it’s thermal ablation cousins, EVLA and Radiofrequency Ablation (RFA), Clarivein® involves starting an IV under ultrasound guidance using a little bit of local anesthetic to make starting the IV more comfortable. Unlike EVLA and RFA, NO HEAT IS REQUIRED to close off veins.
Since no heat is required, NO TUMESCENT ANESTHESIA IS REQUIRED! This essentially removes the only discomfort involved in venous closure.
“OK Rosen, how is the procedure performed?”
Well…in a very similar way as the Endovenous Laser Ablation procedure is performed: start IV under ultrasound guidance (with just a little bit of local anesthetic used to make that process more comfortable for patients)…then through the IV, place the Clarivein® catheter (again, under guidance with ultrasound). Once the device is in place, it is activated and rotates gently but rapidly in the vein at the same time a sclerosant chemical called Sodium tetradecyl sulfate is injected (we will talk at length about this chemical during our lecture on Sclerotherapy as it is the same chemical used to treat spider and varicose veins,too). The device is slowly backed out of the vein and it seals the vein shut as it goes. During the procedures that I’ve done thus far, patients have stated that they do not feel discomfort (amazing!). In fact, during the post-procedure week patients have also stated such things as “it didn’t feel like I even had a procedure done!”. Minimal, if any, discomfort. Minimal, if any, bruising.
“Yeah Rosen…but does it work?!”
In fact, it does! I have had results that are nearly identical to EVLA with essentially pain-free experiences for my patients who have had Clarivein® procedures. Mind-blowing.
“Yeah Rosen…but what’s the catch?”
The catch, if you will, is insurance coverage. Though it is a proven technique…and by proven, I mean studies published in peer-reviewed journals pitting MOCA against thermal ablation…many insurance carriers still have chosen to call this procedure “investigational”. I have a pretty good feeling that if the powers-that-be at these insurance carriers had to choose which procedure they would rather have for themselves, they would likely want Clarivein®.
Although I trained to do the procedure almost 3 years ago, I did not incorporate the procedure into my armamentarium of procedures until the Fall of 2014. Since then, some insurance carriers have begun to take a progressive, favorable view of this procedure and some (lucky) patients have obtained coverage.
The procedure is available to all; for those without insurance or whose insurers refuse to cover Clarivein®, I will be happy to work with you to make the procedure as affordable as possible. Payment plans are an option.
That wraps up this installment of Rosen Vein Care Lectures. Stay tuned for our next episode where I will discuss Sclerotherapy and the treatment of spider and varicose veins. As always, for more information on this or other topics, feel free to dig around my website.
For specific answers to your concerns regarding varicose/spider veins and/or chronic leg discomfort, call 847-272-8346 to schedule your initial consultation appointment with me. The consultation appointment is about 1 hour long. We will spend the time learning more about you and your concerns. Consultations are generally covered by commercial insurance as well as Medicare. Many procedures may be covered by insurance,too. However it may often take weeks to gain authorization for treatment by your insurer..so schedule the consultation ASAP!
See you soon!
